Road Rash

Reprinted with permission of the Rivendell Reader and the
UltraMarathon Cycling Association. For more information on endurance
cycling, go to www.ultracycling.com

If you ride a bike, you have probably gone down — at least several
times. No matter how hard we try, if we ride enough, the ground
will meet up with us eventually.

Unfortunately road rash frequently ends up as quite noticeable scars if
the road rash is deep. Go to a race and look at the elbows, knees, forearms,
legs and chins of the racers if you want to see a varied collection of
scars.

The purpose of the article is to review the modern way to treat road rash,
to minimize pain, control bleeding, and optimize healing, as well as what to
avoid, how to reduce scarring if it occurs and how to detect it early if it
should occur.

You have hit the ground — let's assume you were not knocked unconscious;
all of your body parts move well, there are no obvious breaks, and you are
not spurting blood. With no visit to the ER eminent, what do you do now?
That depends on what you have with you for first aid. Dr. Arnie Baker, in his
book Bicycling Medicine, has recommended first aid kits for your car and a
more sophisticated kit for a group or medical personnel. With the limited
amount of space and weight allowed, I would recommend that the one thing
you should carry is what you should have with you anyway to prevent saddle
sores — Vaseline petroleum jelly — the first aid kit in a jar.

Want to go all out? Add several non-stick Telfa pads and a flattened
soft, adherent Coban elastic bandage, or cheaper variant. When you crash,
cover your wounds, and go home to give your wounds the care they need.

The primary goal of wound care is getting the wound clean. The primary
deterrent to cleanliness is pain. To prevent pain get a tube of ELA-max from
your local pharmacy. This recently available topical over-the-counter
Xylocaine preparation should be rubbed into the wound gently for fifteen
minutes. Almost total pain control should be achieved. Scrub the wound
aggressively with sterile gauze, sterile saline and Hibiclens®. Stop when
the wound is red, raw and totally clean.

To stop oozing use pressure with sterile saline. If oozing stubbornly
persists, use gauze and hydrogen peroxide (3%) which should almost totally
stop bleeding and oozing within five to ten minutes. Hydrogen peroxide works
because it is a gentle cauterizing agent. However, its use is now usually
avoided for routine wound care because it is adding more damage, via cautery,
to your wound. Use it only for stubborn bleeding.

Cover the wound with Vaseline petroleum jelly. A number of studies have
shown that allergic contact dermatitis from topical antibiotics (especially
neomycin-containing products, e.g. Neosporin, family antibiotic cream or
ointment, triple antibiotic ointment or cream) is so common that you are
much better off using Vaseline petroleum jelly (and not Vaseline petroleum
cream). Cover the Vaseline with sterile Telfa pads. Use a Coban bandage, or
coban-equivalent, to hold the Telfa in place.

Synthetic semi-occlusive wound covers such as Vigilan, Spenco Second Skin
and others like Tegaderm may be used instead of the above. You can let them
stay on unchanged for up to three days, but they are expensive and the rate
of infection can slightly increase. Change your dressings once or twice daily
for Vaseline and Telfa and every two to three days for synthetic dressings.

Cleanse the wounds with soap and water (use sterile saline if you don't
trust your local water supply's chlorination program) before applying the
dressing. The goal is to eliminate any chance of scab formation. A scab
allows the wound to heal in the reverse image of the scab. The preceding
technique will ensure that your wound will totally heal in from the bottom.
When the wound is totally filled in and no raw skin remains you can stop
dressing changes.

A sudden increase in redness developing at the pink wound site indicates
the formation of a thick, elevated scar, also known as a keloid or
hypertrophic scar. This probably will occur soon after the wound is totally
healed. To prevent scarring, daily massage (five to ten minutes three times
daily) with lotion or Vaseline is recommended beginning immediately after
total wound closure.

Better yet, use a silicone gel sheeting held in contact with
hypoallergenic waterproof first aid tape (hospital name Blenderm) for four
to eight weeks. Curad silicone gel Band-Aids, which have just become
available, can simplify this treatment for small wounds.

If you have large areas of road rash, make your own silicone gel
sheeting. (See below.)

The purpose of this article has been to minimize the pain, misery and
scarring of road rash. Your scars may not be near as impressive to future
generations, but that should be greatly preferable to the discomfort of
kneeling on your scars in future years or the inability to rest your elbows
on a table because of the hardness or discomfort of the scars on your
elbows. Perhaps taking a photograph if your bright, fresh wounds will be
more impressive in the future than the painful scars that might result
from them.

Instructions: Cover cookie pan with silicone gel to an even depth
of 2-4 millimeters. Let dry. Cut into pieces large enough to cover wounds.
Cover wounds after daily bathing. Remember to only use silicone gel sheeting
on totally healed wounds. The chance of infection is high if you start it
too soon. Remove before your next bath.

In addition to the previously mentioned substances containing neomycin,
the use of Benzocaine or Solarcaine and topical Benadryl should be avoided
in all wound care efforts. These substances can frequently cause allergic
contact sensitization and severely exacerbate any wound and increase greatly
the chance of scarring.

Dr. Dan Siegel's recipe for silicon gel sheeting: Put a marble sized
dollop of Silicone window caulk into the center of a plastic baggy. Gently
press down spreading the caulk out, but do not let it get to the edge of the
baggy. Trim the edges, let it sit and dry for a day or two and then remove
the plastic from the top and bottom and allow to dry further. If you make
them in advance, or start just after your accident, you should be ready to
use them when your wounds have healed.

How To Get It
Cheap

Sterile saline: Sterile saline available in large bottles is
usually considered not sterile after one use. It can also be very expensive.
Go to Target store's contact lens supply department and get a one-pint bottle
of Target Multi-use Sterile Saline spray Eyewash for $1.00 to $1.49.

Moore Medical Supply (www.mooremedical.com): Moore Medical is a medical
supply company that offers individual personal accounts. A group of
individuals or a bike club could easily order the amounts required from
Moore Medical to make it worthwhile to assemble several kits at a reasonable
price. Purchasing Moore brand products rather than the name brand products
will typically save you 25-50%. I recommend that you consider Moore
Non-Adherent pads (NA, item number 10776) rather than Telfa, and Moore
Medi-Rip® self adherent bandages rather than Coban. This bandage easily rips
rather than requiring scissors to tear it. Its item number is 17453. Moore
gauze pads, item number 08251, are significantly less expensive than the
name-brand products. In addition, Tegaderm® transparent dressing and Spenco
Second Skin dressings are available at a reasonable price from Moore
Medical.

Although I would normally recommend buying at home, finding these products
at a regular drug store or medical supply store can be very difficult for
non-medical personnel — like finding a nice lugged steel sports-touring
frame in all sizes at your local bike store.